DEQ Form 626-WER "Water Distribution Systems and Ground Water Wells Engineering Report Form" - Oklahoma

What Is DEQ Form 626-WER?

This is a legal form that was released by the Oklahoma Department of Environmental Quality - a government authority operating within Oklahoma. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on July 1, 2013;
  • The latest edition provided by the Oklahoma Department of Environmental Quality;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DEQ Form 626-WER by clicking the link below or browse more documents and templates provided by the Oklahoma Department of Environmental Quality.

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Download DEQ Form 626-WER "Water Distribution Systems and Ground Water Wells Engineering Report Form" - Oklahoma

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Oklahoma Department of Environmental Quality
Water Quality Division | Phone: 405-702-8100
Construction Permitting Section
707 N. Robinson, OKC, OK 73102-6010
P.O. Box 1677, OKC, OK 73101-1677
Water Distribution Systems and Ground Water Wells
Engineering Report Form
The __________________________________________ proposes the construction of a waterline
extension(s), ground water well(s), pumping facility, chlorination facility, and/or water storage facility in
the manner indicated by the information contained herein and by the plans, profiles, specifications, and
other data attached hereto. The plans and specifications have been approved and signed by the proper city
officials or owner and an application for a permit properly executed by the Mayor, Chairman of the Board or
owner accompanies this report.
I. General Information
1. Name of Facility _________________________________________________________________________
2. PWSID Number _________________________________________________________________________
3. Legal Description: ___/4, ___/4, ___/4, of Section ______________, T- ___ - ___ , R - ___ - ___ , I.M./C.M.,
County _________________________________________
4. Source of Water Supply ___________________________________________________________________
a. Surface _______________ , Ground _________________ , or Purchase _______________________
b. Community
Non-Community
c.
Waterline is for distribution
Raw water transmission line (if, so then go to P.E. certification)
5. Population Served by System: _____________________________________________________________
6. Type of Service Area (Rural waterline extension, Municipal, Mobile Home Park, Camp Grounds, School, Etc.):
_______________________________________________________________________________________
7. Number of Service Connections (System): ____________________________________________________
Yes
No
8. Technical specifications for the proposed waterline extension, booster pump(s),
and water well(s) are provided?
If No, the most current City Ordinances or Standards are referred to?
If Yes, the Ordinances/Standards are included or on file with the Construction Permit
Unit, Water Quality Division, Oklahoma Department of Environmental Quality.
DEQ Form No. 626-WER
July 2013
Oklahoma Department of Environmental Quality
Water Quality Division | Phone: 405-702-8100
Construction Permitting Section
707 N. Robinson, OKC, OK 73102-6010
P.O. Box 1677, OKC, OK 73101-1677
Water Distribution Systems and Ground Water Wells
Engineering Report Form
The __________________________________________ proposes the construction of a waterline
extension(s), ground water well(s), pumping facility, chlorination facility, and/or water storage facility in
the manner indicated by the information contained herein and by the plans, profiles, specifications, and
other data attached hereto. The plans and specifications have been approved and signed by the proper city
officials or owner and an application for a permit properly executed by the Mayor, Chairman of the Board or
owner accompanies this report.
I. General Information
1. Name of Facility _________________________________________________________________________
2. PWSID Number _________________________________________________________________________
3. Legal Description: ___/4, ___/4, ___/4, of Section ______________, T- ___ - ___ , R - ___ - ___ , I.M./C.M.,
County _________________________________________
4. Source of Water Supply ___________________________________________________________________
a. Surface _______________ , Ground _________________ , or Purchase _______________________
b. Community
Non-Community
c.
Waterline is for distribution
Raw water transmission line (if, so then go to P.E. certification)
5. Population Served by System: _____________________________________________________________
6. Type of Service Area (Rural waterline extension, Municipal, Mobile Home Park, Camp Grounds, School, Etc.):
_______________________________________________________________________________________
7. Number of Service Connections (System): ____________________________________________________
Yes
No
8. Technical specifications for the proposed waterline extension, booster pump(s),
and water well(s) are provided?
If No, the most current City Ordinances or Standards are referred to?
If Yes, the Ordinances/Standards are included or on file with the Construction Permit
Unit, Water Quality Division, Oklahoma Department of Environmental Quality.
DEQ Form No. 626-WER
July 2013
Yes
No
9. The area of the proposed development: ___________________________________
If area of development is 1 acre or more, has the developer/builder obtained a DEQ
Storm Water Construction Permit?
Developers/builders are required to obtain a DEQ Storm Water Construction Permit for a construction
site that will disturb five (5) acres or more in accordance with OPDES, 27A O.S. § 2-6-201 et seq.
II. Waterline Extension Technical Information
A. Municipal Waterline Extensions
Yes
No
1. The proposed waterline system is designed to maintain a minimum pressure of 25 psi
at all points under all conditions of flow?
2. Hydraulic analysis based on flow demands and pressure requirements is used to size
all water mains?
3. Hydraulic analysis is provided (hydraulic analysis is required for the review process)?
4. Number of service connections to be served by this waterline after the construction is complete: _____
5. A minimum waterline size of six (6) inches in residential areas and eight (8) inches in
high value districts are proposed?
6. The normal static pressure throughout the area to be served will range from __________ to ______ psi.
7. The normal dynamic pressure throughout the area to be served will range from _______ to ______ psi.
8. Flushing hydrants that discharge above the ground surface are provided for
dead-end lines?
9. Positive closing valves are located so that a single break in the line will require no more
than 500 linear feet of line to be disconnected in high value districts and 1,320 linear
feet in other areas?
10. Hydrants are provided at each intersection and at intermediate points so spacing does
not exceed 600 feet?
11. Hydrants should have one (1) 4 ½ inch pumper outlet, not less than two (2) 2 ½ inch hose outlets.
12. Hydrants, with 4 ½ inch pumper outlets are to be connected to mains smaller than
6 inches?
If Yes, explain ___________________________________________________________________________
___________________________________________________________________________
13. Drains from hydrant barrels do not connect to any sanitary sewer or storm drain?
14. Air relief valves are provided at high points?
DEQ Form No. 626-WER
July 2013
Yes
No
15. In large mains, blow offs are provided at low points?
16. Are there any cross connections between the public water supply and any sanitary
sewer or storm drain?
B. Rural Waterline Extensions
1. The proposed waterline system is designed to maintain a minimum pressure of 25 psi
at all points under all conditions of flow?
2. Hydraulic analysis based on flow demands and pressure requirements is used to size
all water mains?
3. Hydraulic analysis is provided (hydraulic analysis is required for the review process)?
4. Number of service connections to be served by this waterline after the construction is complete: ______
5. The normal static pressure throughout the area to be served will range from ____________ to _____ psi.
6. The normal dynamic pressure throughout the area to be served will range from _______ to _______ psi.
7. Flushing hydrants that discharge above the ground surface are provided for
dead-end lines?
8. Valves are located at no more than two (2) mile intervals?
9. Air relief valves are located at high points in the distribution system?
10. Are there any cross connections between the public water supply and any sanitary
sewer or storm drain?
C. Installation of Waterlines (To Be Completed For All Municipal and Rural Waterline Extensions)
1. Specifications:
a. Pipe material
Applicable Standard
Class
Pressure Rating
Cast Iron
________________________
____________
________________________
Ductile Iron
________________________
____________
________________________
PVC
________________________
____________
________________________
HDPE
________________________
____________
________________________
Other
________________________
____________
________________________
b. Minimum Depth of Cover (30 inches minimum): ____________________________________________
Yes
No
c. Pressure and Leakage Testing in accordance with AWWA C-601?
d. Disinfection Procedures in accordance with AWWA C-651?
DEQ Form No. 626-WER
July 2013
Yes
No
e. Reaction blocking is provided at all bends, tees, and hydrants?
f. Installation of waterlines meets AWWA and Oklahoma DEQ construction standards?
2. Does this water line project involve construction along any state or federal highway?
If yes, has the Oklahoma Department of Transportation (ODOT) been notified, and, do
the plans show the location of all affected utilities on file with ODOT?
3. Minimum horizontal separation between water and sewer lines is 10 feet?
If no, please indicated minimum possible horizontal separation: _________________________________
(If 10 feet of separation is not possible, the water line must be constructed in a separate trench and the
sewer line designed, constructed, and tested as water line pipe in accordance with OAC 252:656-5-4 (c).
4. Minimum horizontal separation between plastic water lines and gasoline storage tanks
(including appurtenances) is at least 50 feet?
If no, cast iron must be used for water line pipe and in no case be closer than 10 feet to any part of the
storage tank system.
5. Minimum horizontal separation between water and all parts of septic tanks and
absorption fields, or other sewage treatment and disposal system is 15 feet?
6. Minimum horizontal separation distance between waterlines existing or future storm
sewers, raw water, oil and gas (includes natural gas), and buried electric lines is 10 feet?
If no, the minimum horizontal separation for storm sewer lines is ___ feet, raw waterlines is ___ feet, oil &
gas lines is ___ feet, and buried electric lines is ___ feet.
7. Where waterlines and sewer lines intersect the minimum vertical separation (edge to edge) is ____ inches.
8. Hydrants or other flushing devices capable of flow velocities of at least 2 feet per
second in the waterline are installed at all dead-ends?
9. Proposed waterline extension involves surface water crossings?
If Yes, above water crossings
or under water crossing
. Width of crossing ___________________ ft.
If above water crossing:
a. waterline is adequately supported and anchored?
b. waterline is adequately protected from damage and freezing?
c. expansion joints are provided at each end of the crossing?
d. waterline is easily accessible for repair?
If under water crossing is greater than 15 feet:
a. minimum cover provided is ________ feet,
b. waterline has flexible watertight joints?
c. valves are provided at both ends of the water crossing?
DEQ Form No. 626-WER
July 2013
Yes
No
d. the valve closest to the water source is in a manhole?
e. permanent sampling taps are provided on each side of the valve within the manhole?
10. Waterlines proposed:
Line Segment
Diameter (inches)
Length
Material
_______________
___________________
__________________
__________________
_______________
___________________
__________________
__________________
_______________
___________________
__________________
__________________
_______________
___________________
__________________
__________________
_______________
___________________
__________________
__________________
11. Onsite inspection of the proposed waterline construction will be inspected by:
Engineering Firm?
Owner?
Other (please specify)? ____________________________________________________________________
12. Is this water line for Commercial?
or Residential?
13. What is the maximum square footage of the dwelling or building connecting to the water line? ______ sf
14. International Fire Code (IFC):
Building Classification ___________________ , Minimum fire flow _______ gpm, Duration ______ hours.
Not Applicable
15. What is the available fire flow for one and two family dwellings less than 3,600 sf? _______ gpm
(1,000 gpm is required.) If less than 1,000 gpm is available has the fire chief authorized such
reduction in flow, please provide letter for proof of reduction and acceptance.
16. What is the available fire flow for other buildings? _______ gpm
(Please refer to table B105.1 of the 2009 IFC).
III. Ground Water Wells
1. General information
Yes
No
a. A completed “Checklist for Well Head Protection” is required for all new well
construction. A completed “Checklist for Well Head Protection” is included in
the plan documents.
b. Number of wells ________
c. Capacity of well(s): (# 1) _______ , (# 2) _______ , (# 3) ________ , (# 4) _________
d. Well depth(s) (# 1) ________ , (# 2) ________ , (# 3) ________ , (# 4) ________
DEQ Form No. 626-WER
July 2013
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